13- Pre operative Explains Flashcards
What is the mechanism of action of heparin?
Heparin works by causing the formation of complexes between antithrombin and activated thrombin, as well as factors 7, 9, 10, 11, and 12. This inhibits the clotting cascade and prevents the formation of blood clots.
What are the advantages of low molecular weight heparin (LMWH)?
Low molecular weight heparin offers several advantages compared to unfractionated heparin. These include better bioavailability, a lower risk of bleeding, a longer half-life, little effect on the activated partial thromboplastin time (APTT) at prophylactic dosages, and a lower risk of heparin-induced thrombocytopenia (HIT).
What are some complications associated with heparin use?
Complications of heparin use can include bleeding, osteoporosis, heparin-induced thrombocytopenia (HIT) which typically occurs 5-14 days after the first exposure, and anaphylaxis.
What are the specific features of propofol as an IV induction agent?
Propofol has a rapid onset of anesthesia, but it may cause pain upon IV injection. It is rapidly metabolized with minimal accumulation of metabolites. Additionally, propofol has proven antiemetic (anti-nausea) properties and moderate myocardial depression. It is widely used for maintaining sedation in the intensive care unit (ITU), total IV anesthesia, and for daycase surgery.
In surgical patients who may need a rapid return to the operating theater, which type of heparin is preferred?
In surgical patients who may require a rapid return to the operating theater, administration of unfractionated heparin is preferred. This is because low molecular weight heparins have a longer duration of action and are more challenging to reverse if necessary.
What are the specific features of sodium thiopentone as an IV induction agent?
Sodium thiopentone has an extremely rapid onset of action, making it the agent of choice for rapid sequence induction. However, it may cause marked myocardial depression and the buildup of metabolites. It is not suitable for maintenance infusion and has little analgesic effects.
What are the specific features of ketamine as an IV induction agent?
Ketamine may be used for the induction of anesthesia. It has moderate to strong analgesic properties and produces little myocardial depression, making it suitable for anesthesia in individuals who are hemodynamically unstable. However, ketamine may induce a state of dissociative anesthesia, which can result in nightmares.
What are the specific features of etomidate as an IV induction agent?
Etomidate has a favorable cardiac safety profile with minimal hemodynamic instability. It does not possess analgesic properties. However, it is unsuitable for maintaining sedation as prolonged or even brief use may lead to adrenal suppression. Post-operative vomiting is common with the use of etomidate.
What are the possible causes of aortic stenosis?
Aortic stenosis can occur as a result of rheumatic fever, aging, and calcific changes. In congenital cases, it may occur earlier due to the calcification of a bicuspid aortic valve, which affects around 1-2% of the population.
What are the symptoms of aortic stenosis?
Symptoms of aortic stenosis may include exertional angina (chest pain during physical activity) and syncope (fainting).
What is the preferred investigation for diagnosing aortic stenosis?
When aortic stenosis is suspected, trans thoracic echocardiography is the investigation of choice for evaluation and diagnosis.
What are the severity classifications for aortic stenosis based on mean gradient and aortic valve area?
The severity of aortic stenosis can be classified as mild (mean gradient <25 mmHg, aortic valve area >1.5 cm²), moderate (mean gradient 25-40 mmHg, aortic valve area 1.0-1.5 cm²), or severe (mean gradient >40 mmHg, aortic valve area <1 cm²).
What are the treatment options for aortic stenosis?
The treatment for aortic stenosis typically involves either transcatheter or open aortic valve replacement, depending on the individual’s condition and medical evaluation.
What are the recommended preparations for elective surgery?
For elective surgery, it is important to consider a pre-admission clinic to address any medical issues. Blood tests including FBC, U+E, LFT’s, clotting, and Group and Save should be conducted. A urine analysis, pregnancy test, and sickle cell test may also be necessary. Additional tests such as ECG and chest x-ray should be performed based on the proposed procedure and patient fitness. Assessing risk factors for deep vein thrombosis and formulating a plan for thromboprophylaxis is crucial.
How should diabetic patients be prepared for surgery?
Diabetic patients have a higher risk of complications, especially if their diabetes is poorly controlled. Patients with diet or tablet-controlled diabetes may have their medication omitted, with regular blood glucose level checks. Poorly controlled or insulin-dependent diabetics may require an intravenous sliding scale. Potassium supplementation should also be given. Diabetic cases should be prioritized for surgery.
What preparations are necessary for emergency surgery?
For emergency surgery, it is important to stabilize and resuscitate the patient as needed. Antibiotics should be considered if required, and their administration should be determined. If major procedures are planned, particularly when coagulopathies are present or anticipated, the blood bank should be informed. Consent and informing relatives should not be forgotten.
Are there any special preparations for specific procedures?
Yes, some procedures require special preparations. For thyroid surgery, a vocal cord check is necessary. For parathyroid surgery, methylene blue may be considered to identify the gland. Sentinel node biopsy may require a radioactive marker or patent blue dye. Surgery involving the thoracic duct may require the administration of cream. Pheochromocytoma surgery will need alpha and beta blockade. Surgery for carcinoid tumors may require covering with octreotide. Colorectal cases may require bowel preparation, especially for left-sided surgery. Thyrotoxicosis may require Lugol’s iodine or medical therapy.
What are the main stages of wound healing?
The main stages of wound healing include haemostasis, inflammation, regeneration, and remodeling.
What happens during the haemostasis stage of wound healing?
During the haemostasis stage, which occurs minutes to hours following an injury, vasospasm in adjacent vessels, platelet plug formation, and the generation of a fibrin-rich clot take place.
What occurs during the inflammation stage of wound healing?
The inflammation stage typically occurs from day 1 to day 5 after an injury. Neutrophils migrate into the wound, and growth factors such as basic fibroblast growth factor and vascular endothelial growth factor are released. Fibroblasts replicate and migrate into the wound, while macrophages and fibroblasts facilitate matrix regeneration and clot substitution.
What happens during the regeneration stage of wound healing?
The regeneration stage typically occurs from day 7 to day 56. Platelet-derived growth factor and transformation growth factors stimulate the activity of fibroblasts and epithelial cells. Fibroblasts produce a collagen network, angiogenesis occurs, and the wound begins to resemble granulation tissue.
What occurs during the remodeling stage of wound healing?
The remodeling stage takes place from 6 weeks to 1 year after an injury. Fibroblasts become differentiated (myofibroblasts) and aid in wound contraction. Collagen fibers are remodeled, microvessels regress, and a pale scar forms.
What are some factors that can impair the wound healing process?
Conditions such as vascular disease, shock, sepsis, and jaundice can impair microvascular flow and negatively impact wound healing. Additionally, certain drugs like nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, immunosuppressive agents, and anti-neoplastic drugs can impair wound healing.
What are the potential problems with scars?
Hypertrophic scars are characterized by excessive amounts of collagen within the scar. They may contain nodules and can develop contractures. Keloid scars also have excessive collagen, but they extend beyond the boundaries of the original injury and can occur even after trivial injury. Keloid scars do not regress over time and may recur after removal.